BRASH Syndrome

Excerpt

BRASH syndrome—an acronym for bradycardia, renal failure, atrioventricular nodal blockade, shock, and hyperkalemia syndrome—describes a self-perpetuating cycle of severe bradycardia and hyperkalemia that occurs when atrioventricular nodal blockers are used. Although the use of the acronym BRASH is a more recent development, the connection between these medications and renal failure has been described in the literature for years.

Since their development in the 1960s, atrioventricular nodal-blocking medications, such as β-blockers and calcium channel blockers, have been used to treat conditions such as coronary artery disease, hypertension, and tachyarrhythmias, including atrial fibrillation. These medications act on the atrioventricular node to attenuate conduction, leading to decreased heart rates. Similar to all pharmaceuticals, atrioventricular nodal blockers are associated with adverse reactions. The most common adverse effects include fatigue, dizziness, sleep disturbance, and dyspnea. However, BRASH syndrome is a frequently overlooked complication that can lead to significant morbidity and mortality if not properly recognized and treated.